Crack a baby's back

A popular Melbourne chiropractor uses spinal manipulations to treats conjunctivitis and ear infection in babies and children. His YouTube videos have been viewed by millions, including a doctor who says 'There's not many things that make an orthopedic surgeon emotional, but when you see a premature baby having its back cracked, it literally makes my eyes water.'

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Transcript

Ian Rossborough: I have to unfortunately just extend her a little bit to get it in the right place. [crack] [baby cries] That's why we be quick. [loud crying] Hey darling, hey, hey…

Ann Arnold: It's one crack, but it divides the healthcare worlds of doctors and chiropractors.

John Cunningham: Oh. There's not many things that make an orthopaedic surgeon emotional, but when you see a premature baby having its back cracked, it literally made my eyes water.

Ann Arnold: Melbourne surgeon John Cunningham, who specialises in spines, watched that YouTube video, and cannot fathom why a chiropractor would adjust the spine of a newborn.

John Cunningham: There would be risks of harm. There would be risks that the child could suffer some sort of fracture. Why would you do it? This is the thing that goes through my mind when I watch that video, is why on earth would you do that to a newborn?

Ann Arnold: Because, says chiropractor Ian Rossborough, this baby with colic, a term generally used for young babies' unexplained bouts of crying, was helped by it.

Ian Rossborough: When you see the patients return with these children, they always report that the child is just so much more comfortable, they sleep so much better, they eat so much better.

Ann Arnold: The gap between many chiropractors and evidence-based medicine seems ever wider. The only really strong, often-cited evidence is for lower back pain. But a number of chiropractors continue to push the envelope about what they can treat and how they can help people. Their regulator is accused of being unable to reign them in.

John Cunningham: The Chiropractic Board is meant to be serving and protecting the public. Unfortunately it seems to want to protect its own practitioners rather than the general public a lot of the time.

Ann Arnold: In February, surgeon John Cunningham made a formal complaint to AHPRA, the Australian Health Practitioners Regulation Agency, calling for the Chiropractic Board to be sacked.

John Cunningham: The Chiropractic Board has been in existence now for I think a little over five years. Many complaints have been put in about chiropractors, and the strongest response I've ever seen from the Chiropractic Board is a strongly worded letter to the chiropractor to say, 'Please don't do that again,' or, 'Please improve.' They are lacking any sort of bite, any sort of clout. They have the legislative ability to come down on their members and demand that they improve their practice, but they seem very reluctant to.

Ann Arnold: The under-pressure board last month issued an edict to chiropractors: stop advertising that your spinal manipulations can treat 'general wellness, organic diseases and infections'. Especially for children, don't say your manual therapy can help autism, or bedwetting, or other such conditions. Don't promote anti-vaccination messages; that's because a significant number of chiropractors oppose childhood vaccination. And stick to treatments that have a strong evidence base.

Welcome to the chiro wars, on Background Briefing. I'm Ann Arnold.

Despite that apparently stern direction, chiropractors are still flouting the rules. The Chiropractic Board had previously warned about advertising needing a high level of evidence for claims, in September last year and January this year.

Hundreds of examples of chiropractors' websites that appeared to breach the law on healthcare advertising were brought to the board's attention in January. But the group Friends of Science in Medicine, which collated the sites, say that nearly all of those claims remain online. Hundreds more had been submitted in previous years.

As well, more than a dozen individual complaints made to the Chiropractic Board over the past six months remain unresolved, although the Board says it is working on them and has referred three to the ACCC. But it seems the board can't keep up with the spread of apparently misleading advertising claims.

This is Ken McLeod, from Friends of Science in Medicine.

Ken McLeod: Some of our group are practicing doctors, some specialists, some academics, and we are all just horrified at the claims that are going totally unregulated, unnoticed by the regulatory authorities

YouTube video:

Ian Rossborough: [Baby cry] That's a good little trick that one, just wriggle their bottom. Oh and spew on the chiropractor. That's all right, it happens every day. I don't have any pants without baby spew on em'…

Ann Arnold: Chiropractor Ian Rossborough is a popular practitioner in Melbourne who now, thanks to his YouTube videos, has an international following. The videos suggest the benefits that patients have had, for a range of conditions, after their treatments.

In this one, viewed by 834,000 people, Dr Ian, as he's known, is working on the baby with colic, who we heard earlier. She was born premature and had not been settling well. Ian Rossborough has the baby tummy down across his lap, with her back slightly dipped.

YouTube video:

Ian Rossborough: So I'm just going to use the end of my two fingers, imagine that bit there is her vertebra. I'm just going to sneak my fingers either side of it like that. Then I'm just going to take it down like that to get the vertebra into the right position, and the correction will just be like that. It's about the amount of pressure you can tolerate on your own eyeball. But it'll look more than that. Because she's so flexible, I'm gonna have to get some extension in her spine. I'm going to take that contact there like that. I have to unfortunately just extend her a little bit to get it in the right place. [crack] [baby cry] That's why we be quick. [loud crying] Hey darling, hey, hey…

Ann Arnold: Watching the video, when the crack and sudden movement comes, it's a shock. Ian Rossborough agrees it was a loud one.

Ian Rossborough: Yeah absolutely. You can see that, you hear that cavitation. I got to tell you, in all the years that I've been practising that was quite loud, coming out. That was a loud one.

Ann Arnold: But he says that doesn't mean it's harmful.

Ian Rossborough: It's a noise that is made when the pressure is taken off the joint, but it doesn't reflect the amount of pressure that was used.

Ann Arnold: Darwin paediatrician Paul Bauert also watched the video, and gave his opinion to Background Briefing.

Paul Bauert: I recognise the concern that the parents had, that they feel that there is a problem there, they've come across a charismatic man who was showing attention, who was saying, look, I know exactly what's going on, and look here's the treatment and look I've cured the baby. And the diagnosis and the cure are bogus.

Ann Arnold: It's this suggestion that spinal manipulation helps with a baby's colic that the Chiropractic Board has specifically told chiropractors not to make. And that's because there is not sufficient evidence to support it. The benefit is unproven, and so is the risk to the baby.

Paul Bauert: Well, that's the concern that it may well be harmful if you are damaging those cartilaginous vertebral bodies. And there's the potential risk there of interrupting blood supply to that area, and down the track at a later stage having back problems because of maldevelopment of those vertebral bodies.

Ann Arnold: Many medical practitioners, and some chiropractors, say there should be an industry-wide adverse outcomes database, because chiropractic treatments and effects are relatively under-researched.

Dr Bauert is head of paediatrics at Royal Darwin Hospital.

Paul Bauert: Once again, it would be really beneficial if proper records were kept of the numbers of babies that were being treated this way…'treated' is the wrong word but who are being handled this way, and seeing their long-term outcomes, but at the moment we have absolutely no way of following this through.

Ann Arnold: When you say there is no benefit, chiropractors and their patients will often say, 'Oh yes there is, we see it day in day out, we see people getting better, we know we are doing good for people, leave us alone to get on with it.'

Paul Bauert: Yes, and many of the people that chiropractors see, particularly around the newborn period, are anxious and concerned. And the chiropractors that I've seen on videos will spend a great deal of time reassuring the parents and at the same time offering them a diagnosis, and offering them treatment. Both the diagnosis and the treatment are bogus but the families feel reassured and less anxious because somebody is taking their concern seriously, somebody is offering them an answer, and somebody is offering them treatment.

Ann Arnold: Chiropractor Ian Rossborough agrees the baby and parents often become more relaxed.

Could that be for other reasons? Could it be that the mother, for example, has become reassured by the whole process of seeing you and she is relaxed and both parents have relaxed, and the baby, they're all just feeling better.

Ian Rossborough: The invisible part of health and healing we will never understand, and that's a fact.

John Cunningham: As a father of four children under the age of seven, I know that, as a young baby, they have periods where they're more settled than others. They have periods when they seem to have colic, or where they're grumpy, or where they don't sleep, and then the next night they'll turn around and they'll sleep the whole night. It's just a normal part of being a baby, that week by week, day by day, their behaviour changes. Now, this chiropractor is taking the credit for doing that, and that's fine, and the parents are very happy with that. I'm a bit more sceptical, and I'd like to ask him, well, where is the evidence that what he did actually had an effect on the child's colic? Just saying that you see these effects all the time is not good enough. If you are seeing these effects all the time, then it must be very easy to put that paper together, that research together.

Ann Arnold: The specific instruction in last month's statement to chiropractors from the Chiropractic Board was:

Reading: 'Claims suggesting that manual therapy for spinal problems can assist with general wellness and/or benefit a variety of paediatric syndromes and organic conditions are not supported by satisfactory evidence. This includes claims relating to developmental and behavioural disorders, ADHD, autistic spectrum disorders, asthma, infantile colic, bedwetting, ear infections and digestive problems.'

Ann Arnold: Ian Rossborough has another video online, showing his treatment of a boy who looks about 7 or 8 and has an ear infection. He is given a neck adjustment.

YouTube video:

John Cunningham: Back on the chair buddy. Look up in the air. He's deaf isn't he.

Mum: Yes terribly.

John Cunningham: I think he's had a fall. About maybe a month or two ago. Even if it wasn't a big one…

Mum: You know what, he did have a bump to the head about a month ago.

John Cunningham: That's what I'm talking about, his head's not on his spine right.

Mum: Lachie, do you remember the fall that you had at school last term? You had a big bump on your head, yeah? You told everybody about it.

John Cunningham: Do you remember that? Did you fall on your head?

Lachie: I slipped onto the concrete.

John Cunningham: His head's not sitting on his spine. It's just not on. And so that would make sense, about a week later, he starts getting a cold, because his immune system just plummets. And then the virus jumps on. And now he's got this bacterial infection…

Ann Arnold: Ian Rossborough then manipulates the boy's neck, pushing it to one side with an audible crack. This video has had over a million views. It's been online since 2013, and it really gets the doctors riled. Paediatrician Paul Bauert said the approach was wrong in several ways.

Paul Bauert: Yes, I mean it was a really worrying video. And, you know, there's absolutely no evidence that your immune system becomes upset by falls. The whole concept of the immune system plummeting and allowing a virus to jump on board as was claimed in that video is unscientific, it's pseudoscience. The boy had a case of acute otitis media. And he was seen in the emergency department.

Ann Arnold: Lachie had a form of middle ear infection.

Paul Bauert: It's a self-limited condition, it usually doesn't require any treatment at all. And the duration of the symptoms vary. The concerning thing to me was the chiropractor described the wax which was draining from the boy's ear as a discharge, and it was just wax which had melted because of the temperature in the middle ear. And then of course had cleared completely the following day because the wax had gone away and the temperature in the middle ear had settled.

Ann Arnold: Dr Paul Bauert.

Martin Krause is a senior neurologist based at Sydney's Royal North Shore Hospital. He also watched this ear infection video, and says the messages it conveys are troubling, because if people then go to a chiropractor for an ear infection, a diagnosis could be missed.

Martin Krause: And even ear infection in the worst case scenario can lead to serious consequences, to permanent disability, hearing loss, it can lead to meningitis and even death. Any kind of infections require a proper diagnostic and a proper treatment. And to be absolutely clear, neck manipulation is not a proper treatment for ear infections. I find this YouTube video irresponsible because it suggests that neck manipulation or manipulative therapy is a cure for infection, and that is not true.

Ian Rossborough: No, that doesn't surprise me at all. When you talk about the inability of another health professional to understand what we do, that does not surprise me at all. You've got to look at the actual paradigm that people are educated under. There's a story that sits behind all of us. I was a registered nurse before I was a chiropractor. And, you know, I worked in the hospital system. And that very mechanistic view, you know, things are explained by chemical reactions, and they're sort of explained by physical mechanisms and so on, you know, a symptom plus a symptom equals a diagnosis. Once your brain is wired that way it's very hard to see how a seemingly gentle, innocuous, small amount of pressure onto a part of the person's body, usually their spine, can have any sort of effect, let alone a massive global health changing effect. But that's only because of the environment that they've been educated in and the environment that they work in.

Ann Arnold: As to the claim by Dr Paul Bauert that his approach was bogus, Ian Rossborough said by email that: 'A caring professional would be thrilled to see someone get well and if they couldn't understand how it happened, then they would respectfully seek to find out.' He says his Gonstead technique of treatment, where spinal manipulation is said to affect nerve irritation which in turn affects other conditions, works.

Ian Rossborough: People come to us with signs of spinal misalignment and biomechanical dysfunction and when we correct it, they will daily come back and report 'this thing that I had forever has gone away'.

Ann Arnold: But that link between the spine, nerves and other illnesses is not supported by high level evidence.

The direction from the Chiropractic Board last month said that:

Reading: 'Advertisers must ensure that any statements and claims made in relation to chiropractic care are not false, misleading or deceptive or create an unreasonable expectation of beneficial treatment.'

Ann Arnold: Ian Rossborough does not believe his videos are making false or misleading claims to the public.

Ian Rossborough: I think ethically that's something that no healthcare practitioner should ever do. And that's why we don't actually promise anything. We put the videos out for education, we put them out there for people to see what's possible. But we'd never actually say to the person 'you come to us and we'll give you this exact result'.

Ann Arnold: Doesn't it give the impression in the videos, though, that something is going to result? If you go to see a chiropractor, you'll get a result for these different kinds of ailments? The boy with ear infection?

Ian Rossborough: I guess people interpret things the way they interpret them but we put them out not to give people hope but just to show what's possible. I don't know if that's a bad thing, I think that's a very good thing.

Ann Arnold: Ian Rossborough says that his office receives up to 200 enquiries a week, from people around the world who have seen his videos. His staff often refer them to other chiropractors. The videos are driving business, but he doesn't see it as advertising, simply educational.

Ian Rossborough: There is a void in the healthcare system around the world, and there's this space that is not filled, and people don't know where they can go to get help. So when we started the videos basically it was an education. It was basically saying to people around the world 'there's this thing that you might not have seen, it might be of benefit to you'…

Ann Arnold: Which is chiropractic.

Ian Rossborough: Yes, which is chiropractic and specifically my specialty, Gonstead chiropractic. And we wanted people to know that it existed and give them an opportunity to go and seek somebody out, to see if they could be helped.

Ann Arnold: Melbourne chiropractor Ian Rossborough.

The Chiropractic Board has been under attack for not taking action against chiropractors who promote their work without a strong evidence base. It spelt this out in the statement to chiropractors last month.

Reading: 'Advertising claims that are contrary to high level evidence are unacceptable. High level evidence will usually take the form of meta-analyses, systematic reviews or one or more high quality and well respected and acknowledged studies.'

Ann Arnold: About three weeks after this was sent out, Ian Rossborough posted a new video. It features his newborn daughter, who had conjunctivitis.

YouTube video:

Ian Rossborough: This is Isla. This is our new beautiful daughter. Isn't she gorgeous? Isla's going to get her first chiropractic check today. It was exactly a week today that she was born. We've had a little look at her, but since last night she has just developed a little bit of conjunctivitis. So I'm interested to have a look and see if there's any nerve irritation there. It's actually quite common…

Ann Arnold: There is no scientific evidence that conjunctivitis is helped by manual manipulation of the neck. In the video, Ian Rossborough adjusts his baby's neck, with two fingers planted under her skull. Afterwards, we see baby Isla wrapped up and content, sleeping.

Ian Rossborough: And I noticed that there was starting to collect some conjunctivitis in both eyes. Like I said earlier about using the spine as a way of maintaining health, I thought, let's check the spine and see if there's a problem there. As it turned out, I found something in her upper cervical region which we commonly see, if the person has that dysfunction in their spine, that conjunctivitis, along with maybe 100 other potential symptoms, is one possible one.

Paul Bauert: Oh look I think…I honestly found that quite unbelievable. To put his finger on the side of the baby's neck and push it and say that he's cured everything and look a minute later the baby is asleep. Honestly, it really was beyond belief. I think this person believes that what he is doing is right, and that's an additional worry, that he is using pseudoscience and believing it. I think children should be kept away from them.

Ann Arnold: Orthopaedic surgeon John Cunningham also believes Ian Rossborough's intentions are good, but his evidence is not.

John Cunningham: What we see is a chiropractor who, I'm sure, like most chiropractors, is dedicated, committed, and well meaning. We see one video where he is manipulating his own child, and he's obviously a caring, doting father. Unfortunately, what he talks about and what he does is just not supported by any evidence.

Ann Arnold: Are you saying that he's being fraudulent in these videos?

John Cunningham: No, no. As I said, I think he means well. I think…I hope that all chiropractors that we see mean well. I don't think they've had the training in critical thinking to realise what good evidence and bad evidence is.

Ann Arnold: John Cunningham, a Melbourne orthopaedic surgeon who belongs to the advocacy group Friends of Science in Medicine.

Chiropractor Ian Rossborough says he believes his YouTube videos conform to the health practitioners' code of conduct. He has a social media risk advisor.

Ian Rossborough: The reason why I enlisted Kirra's help was we are trying to create an educational platform, and we wanted to do it within the confines of the…of our code of conduct, the AHPRA code of conduct. So basically I employed her because she's got experience in making sure that we operate within our code of conduct and we don't, you know, do anything wrong.

Ann Arnold: So how do the regulators—the Chiropractic Board and their administrator, AHPRA—see Ian Rossborough's videos?

Is this a form of advertising, and is it okay? Is it a testimonial? What's the board's view of those kinds of videos?

Wayne Minter: We really can't comment on any individual cases

Ann Arnold: This is Wayne Minter, the chair of the Chiropractic Board, and a practising chiropractor. He said he could not comment on whether there's been a complaint about Ian Rossborough's videos. Most of the time, investigations only arise out of complaints.

Wayne Minter: And we look at every single complaint we receive, and if there are concerns about these types of behaviours, then we certainly encourage the public to lodge a complaint to the board, and we will deal with the matter.

Ann Arnold: As chair of the board, do you have concerns?

Wayne Minter: As chair of the board, I don't really want to get into my personal views on these matters. I can just reiterate that if there is harm, if the public perceive or are concerned about harm to patients, then that is something that the board takes very seriously.

Ann Arnold: It is an offence under the Health Practitioners Act to mislead the public.

Ken McLeod, from the Friends of Science in Medicine advocacy group, has submitted 13 complaints himself in the last six months. Five were about the Board, and eight about individual chiropractors. He says they cover approximately 100 different claims the chiros have made on their websites. But, he says, a check this week showed only one of those claims had since been removed. And he's had no responses from the Board. With the Board made up of mostly chiropractors, Ken McLeod believes it's a case of regulatory capture.

Ken McLeod: My feeling is that the Chiropractic Board has been captured by the chiropractic industry. They're one and the same. And the Board is not interested in rocking the boat or upsetting the gravy train.

Ann Arnold: AHPRA denies this allegation, and says there are community members as well as chiropractors on the Board.

But now the head of paediatrics at Royal Darwin Hospital, Dr Paul Bauert, says he too wants the Chiropractic Board and AHPRA, which administers the Board, called to account. And he wants the regulators to ban chiropractic treatment for children altogether.

Paul Bauert: AHPRA and the Chiropractic Board should be banning any treatment of children and adolescents under the age of 16, 17, until the evidence is available that shows that there may be some effect. The only evidence that's available at the moment, looking at all the published chiropractic literature, the conclusions of all of those studies say that chiropractors might compete with physiotherapists in terms of treating some back problems. But all their other claims are beyond belief, and can carry a range of significant risks.

At the same time, the number of GP referrals to chiropractors for children has grown by 83% over the five years to June 2015. Background Briefing is not suggesting that all chiropractors work without evidence, or that they cannot help individuals. But even within chiropractic, there are concerns that some practitioners are pushing the boundaries too far.

The CEO of AHPRA, Martin Fletcher, who is not a chiropractor, oversees the Chiropractic Board. He maintains the Board is doing a good job.

In February this year, AHPRA received a complaint from the stop the anti-vaccination network, specifically from the Melbourne surgeon John Cunningham, and Dr Rihanna Miles. The complaint was about AHPRA itself and the Chiropractic Board. It was also sent to Jack Snelling, the South Australian premier and chair of the COAG Health Council. It called for the Board to be sacked. It described the failure of the Chiropractic Board and AHPRA to protect consumers from the continued misleading, deceptive, and often unconscionable conduct of chiropractors. Do you accept that there has been a significant failure there?

Martin Fletcher: I don't believe there is a need for the Board to be sacked. The Board and AHPRA have worked very closely together to make sure that the public are protected, and that high standards of chiropractic practice are in place.

Ann Arnold: AHPRA and the Chiropractic Board say time is needed to investigate complaints, and for procedural fairness for the chiropractors in question.

Ken McLeod: How long does it take to make a phone call or send an email and say 'get this off your website'? It's not hard. It's only 30 seconds.

Ann Arnold: In the year 2013/2014, AHPRA closed 104 breach of advertising cases, but referred none for disciplinary action by the board. In the year 2014/2015, AHPRA closed 96 cases and referred one for disciplinary action.

The Board has been criticised for focussing on education rather than enforcement.

Board chair, Wayne Minter:

Wayne Minter: There has been work done by the Board in terms of getting the message out. If there is a misunderstanding or a lack of appreciation of their responsibilities in relation to advertising we certainly will do more to clarify the message. I would say that the educational approach has worked to a significant degree but, like any approach, obviously doesn't achieve its objective 100%.

Ann Arnold: As well as websites, there are many references on chiropractors' Facebook pages to paediatric and adult treatments for which there is little evidence. And there are anti-vaccination messages.

Like nurses and doctors, chiropractors are registered. They have a code of ethics that requires them to deliver care and treatment based on strong scientific evidence.

But the main professional body, the Chiropractors Association of Australia, does not appear to be leading by example. It accepts ads in its newsletter for chiropractic courses to treat colic and the unsettled baby, and tongue tie.

Wayne Minter, the chair of the regulatory board, is a member of the Chiropractors Association.

The latest newsletter from your professional body, the Chiropractors Association, is just out. In it, ads for courses on paediatric chiropractic, one of them is for the unsettled baby, colic, reflux, and persistent crying. Hasn't the Board instructed chiropractors not to suggest they can affect conditions other than muscular skeletal, especially with children?

Wayne Minter: Once again, it depends upon the context. I just want to reiterate that the Board expects chiropractors to practice in an evidence informed, evidence based way, and will be held accountable to those standards. It's all detailed in our code of conduct, and…

Ann Arnold: So does that sound like an evidence based approach to you?

Wayne Minter: I don't know the details of the case, so I really can't comment on that.

Ann Arnold: There's another course being advertised, and these are presumably approved courses for which chiropractors get their continuing professional development points, for 'unravelling tongue tie.' Tongue tie is a condition in babies where their tongue is held down by a piece of skin, isn't it?

Wayne Minter: Yes. Once again, I don't know the details.

Ann Arnold: Can either of you say how a chiropractor would approach a tongue tie?

Wayne Minter: I really can't comment on specific cases, so I can't comment on that.

Ann Arnold: Wayne Minter, who was interviewed with Martin Fletcher from AHPRA.

When young Lachie was taken to chiropractor Ian Rossborough with his ear infection, the treatment was a neck 'adjustment', a sudden sideways movement, with the accompanying crack.

YouTube video:

Ian Rossborough: I love nervous laughter. [Lachie giggles] It could turn into a cry. It's all right buddy, I won't hurt ya. [crack] There ya go. That was a good one wasn't it. Just give him a minute. That'll be a big deal.

Ann Arnold: The main serious documented risk of chiropractic treatment is that neck manipulations may cause a stroke.

Dr Martin Krause is head of neurology for the northern Sydney health district, covering five public hospitals. He's a stroke specialist. He says neck manipulations are associated with a particular type of stroke, a dissection, where there's a tear in the artery wall.

Martin Krause: So several case controlled studies have shown that those people who have a dissection, so a tear in the vessel wall, had five to six times more commonly a neck manipulation in the week prior to the stroke than a similar group of stroke patients who didn't have a dissection. Is that proof beyond any doubt? No it is not. But it's a very strong suspicion that neck manipulations are correlated to dissections and the resulting stroke. The American Heart Association which is the biggest organisation in the world which gives advice on risk factors and management of stroke made a consensus statement in 2014 which exactly said what I just said.

Ann Arnold: Chiropractor Ian Rossborough says the Gonstead technique of neck adjustment, which he practices, is not dangerous because it doesn't involve the rotations that some other techniques use.

There is no significant research which identifies which manoeuvres are the most dangerous. And Dr Martin Krause says that there may be more strokes resulting than we know. There are minor strokes that people don't realise are happening, or dissection in the artery can lead to a later stroke.

The premise many chiropractors work on, that spinal adjustments affect nerves and therefore other bodily functions, is rejected by neurologist Martin Krause.

Many chiropractors talk of the messages running up and down the spine through the nerves to and from the brain, and that any kind of nerve irritation or problems with nerve tone which might be caused by a lesion or a displacement of a vertebra, those in turn cause problems in other parts of the body, or result in generic illnesses. So manipulation of the spine can address that. Do you accept that hypothesis?

Martin Krause: I think this theory lacks any evidence. The theory is not based on science or the current understanding of how the body and the brain works.

Ann Arnold: That's a point chiropractor Ian Rossborough would agree with. He believes that the work he is doing is ahead of scientific research. While he appreciates why the board sets advertising restrictions, he wishes they were not so limiting.

Ian Rossborough: Look, it's extremely limiting but at the same time it's probably right for the point in time, the point in history that we are sitting in. The future is going show us that that was a very limiting decision.

Ann Arnold: Pressure to reign in what chiropractors can promote is now coming from several directions. The February complaint from John Cunningham that called for the board's sacking was also sent to the South Australian health minister, Jack Snelling, who was then chair of COAG's health council. Jack Snelling wrote to the board to ask what they've been doing to deter chiropractors from using false or misleading advertising.

And Background Briefing has learnt HCF, the health insurer, also recently wrote to chiropractors, saying the fund will not cover treatments that don't have a strong evidence base, or unnecessary x-rays, or open-ended preventative treatment for wellness.

But the Chiropractic Board's focus on advertising doesn't extend to what chiros actually do.

Surgeon John Cunningham, from the Friends of Science in Medicine:

John Cunningham: The Chiropractic Board will put out these edicts, they will put out these statements, and the proof will be in the pudding. I hope that over the next 12 months we see that there's results and that the chiropractors clean up their act, especially with regarding advertising.

Ann Arnold: Advertising is one thing, isn't it? But then what people actually do behind their closed doors is another.

John Cunningham: And we will never know what's going on there, unfortunately, yep.

Ann Arnold: Background Briefing's coordinating producer is Linda McGinness, technical production by Leila Shunnar, research by Tim Roxburgh, and the executive producer is Wendy Carlisle, I'm Ann Arnold. A statement from AHPRA is on our website, along with links to the videos we've discussed.